Provider Demographics
NPI:1386063832
Name:JOSEPH, BRADFORD A (CSFA)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-1013
Mailing Address - Country:US
Mailing Address - Phone:770-899-4908
Mailing Address - Fax:
Practice Address - Street 1:2442 PLANTERS MILL WAY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3691
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty